Healthcare Provider Details

I. General information

NPI: 1598812554
Provider Name (Legal Business Name): PAULINE WITT ALLEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14014 STATE ROUTE 31
ALBION NY
14411-9301
US

IV. Provider business mailing address

9 BEACH ST
BROCKPORT NY
14420-1801
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-7066
  • Fax: 585-589-6395
Mailing address:
  • Phone: 585-637-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number073072-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: